2022年最新の実際のJPNTest NAPLEX問題集PDFで100%合格率を保証します
無料NABP NAPLEX試験問題と解答
質問 84
LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.
His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN's medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram
20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1mg. lock-out every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/ dl, K 5.0mmol/L, Na 135mmol/L.
Which of the following medication's dose are adjusted for poor renal function?
- A. Famotidine
- B. Ondansetron
- C. Citalopram
- D. Metoclopramide
- E. Lisinopril
正解: D
解説:
Explanation
Famotidine and Metoclopramide would need to be adjusted for poor renal function. Since his CrCl is less than
50, famotidine would need to be adjusted by decreasing the dose by 50% or increasing the interval to every 36 to 48 hours. Metoclopramide would also need to be adjusted by 50% of the normal dose since his CrCl is less than 40. ACEInhibitors and ARBs should be held if serum K is greater than 5.6 or there is a rise in serum creatinine greater than 30% after initiation.
質問 85
Which of these substances is not used as a compounding preservative?
- A. Benzyl alcohol
- B. Lecithin
- C. Benzalkonium chloride
- D. Sodium benzoate
正解: B
解説:
Explanation
Lecithin is used as a surfactant, not as a preservative. All other listed substances may be used as a preservative in compounding.
質問 86
WM did not receive influenza vaccine prior to the start of this season, it's now December. He did get influenza vaccine last year. Which of the following is correct course of action?
- A. Vaccinate him with influenza vaccine since influenza season lasts until March in your community.
- B. Skip influenza vaccine for this year since he received vaccine last year.
- C. Start Amantadine 200mg daily
- D. Start WM on Tamiflu to prevent him from getting influenza.
- E. Skip influenza vaccine for this year since it's too late.
正解: A
解説:
Influenza vaccine is recommended annually, thus, WM should not skip it this year, and B is incorrect. Also, per the CDC, seasonal influenza outbreaks can occur as early as October, however, most activity peaks in January or later. Thus, it is not too late for WM to receive his vaccine in December, thus A is incorrect. Lastly, antiviral medications such as Tamiflu are an important adjunct to vaccinations. They are recommended as early as possible for any patient with confirmed or suspected influenza who, is 1) Hospitalized, 2) has severe, complicated, or progressive illness or 3) is at higher risk for influenza complications. Thus, WM is not a candidate with the given information and C is incorrect. Starting Tamiflu or Amantadine is not recommended for prevention. It has indication for treatment and prophylaxis.
質問 87
Select the class of Anti-diabetic medication that works in the specified organ to prevent hyperglycemia. Select all that applies. GI tract (B)
- A. Sulfonylureas
- B. Glucagon-like peptide-1 receptor agonists
- C. SGLT2 inhibitors
- D. DPP4 Inhibitors
- E. Thiazolidinediones
- F. Biguanide
- G. Alpha- Glucosidase Inhibitors
正解: B
解説:
Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha- Glucosidase Inhibitors stop α-glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-
1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body. Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion; (iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia.Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in skeletaland cardiac muscle, liver,and adipose tissue. It ameliorates insulin resistance, decreases visceral fat.Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.
質問 88
A 15-year-old presents with 6 days of nasal congestion with thin, clear rhinorrhea. She notes mild facial pain but has had no fevers. She feels her symptoms are improving.
What is the most likely cause of her symptoms?
- A. Moraxella catarrhalis
- B. Viral
- C. Staphylococcus aureus
- D. Haemophilus influenzae
- E. Streptococcus pneumoniae
正解: B
解説:
Explanation
This patient shows symptoms of acute sinusitis. The most common etiology of which is viruses. Indications that an infection is viral as opposed to bacterial included a shorter infection tie (less than 10 days) and no purulent discharge (hers is watery). She does not show any evidence of a complication developing and even notes that her symptoms are improving. If her symptoms were attributed to a bacterium, then the most common cause of acute sinusitis is Streptococcus pneumoniae followed by Haemophilus influenza, then Moraxella catarrhalis. Anaerobic species such as Bacteroides fragilis and Staphylococcus aureus are more commonly found in patients with chronic sinusitis (sinusitis lasting longer than 12 weeks). This is important to realize before indiscriminately providing antibiotics for these patients.
質問 89
Which of these medicines is well-known to cause a positive direct Coombs test?
- A. Nifedipine
- B. Methyldopa
- C. Hydralazine
- D. Labetalol
正解: B
解説:
Explanation
The direct Coombs test is used to test for autoimmune hemolyticanemia - a condition in which the body attacks red blood cells, leading to anemia. Some drugs can cause a positive direct Coombs test - methyldopa being one of the most well-known (via IgG-mediated type II hypersensitivity reaction). Other drugs that can cause this effect include quinidine (IgM-mediated activation) and penicillins (at very high doses).
質問 90
Which of these drugs is used to prevent contrast-induced nephropathy?
- A. Metformin
- B. Spironolactone
- C. Activated charcoal
- D. N-acetylcysteine
- E. Mannitol
正解: D
解説:
Explanation
N-acetylcysteine can be used to prevent contrast-induced nephropathy. Whilst evidence is not overwhelming for use in favor, it does appear to have a clinical impact. N-acetylcysteine is typically given the day before treatment and the day when treatment commences. Other means to prevent contrast-induced nephropathy include adequate hydration, while some studied recommend ascorbic acid.
質問 91
Which of the following are non-pharmacological measure that may control symptoms of gastroesophageal reflux disease?
- A. lower esophageal sphincter tone
- B. Discontinue nicotine use in patients that uses tobacco product.
- C. Increase fat intake to reduce gastric emptying time Reduce intake of food or beverage that may reduce
- D. Remain upright after a meal
- E. Wear tight fitted cloths to increase intra-abdominal pressure.
正解: B
解説:
Explanation
Non-pharmacological measure that may control symptoms of gastroesophageal reflux disease are: Avoid aggravating foods/beverages that may reduce LES pressure alcohol, citrus juices caffeine, garlic, onions or cause direct irritation such as spicy foods or tomato juice should be avoided. Reduce fat intake, remain upright after meals, avoid meal before bedtime. Avoid tight fitted cloths, decrease intra-abdominal pressure.
Discontinue nicotine use. Reduce intake of food or beverage that may reduce lower esophageal sphincter tone.
質問 92
LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.
His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN's medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4 mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10 mg po daily, Citalopram
20 mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10 mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20K at 125 mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K 5.0 mmol/L, Na 135 mmol/L.
Which of the following medication/s should LN be on to prevent the most common side effect of hydromorphone?
- A. Ondansetron for N/V
- B. Dexamethasone for N/V
- C. Docusate sodium / Senna for Constipation
- D. Docusate sodium / Senna for Constipation and ondansetron for N/V
- E. Insulin Sliding scale for hyperglycemia
正解: D
解説:
LN should be on docusate sodium/Senna for constipation and ondansetron for N/V. Dexamethasone has an off label use for N/V that is chemotherapy-associated. It is mostly used as an anti-inflammatory or immunosuppressant agent. Hydromorphone does not cause hyperglycemia. The most common side effects of opioids are nausea, vomiting and constipation.
質問 93
LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA. His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain.
Post-op day 1, LN's medication includes Dexamethasone 8 mg iv q6h with taper dosing, Ondansetron 4 mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10 mg po daily, Citalopram 20 mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10 mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10 mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20 K at
125 mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6 min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K
5.0 mmol/L, Na 135 mmol/L.
Which of the following medication may cause tardive dyskinesia when given at a higher dose and for a long duration?
- A. Famotidine
- B. Metoclopramide
- C. Dexamethasone
- D. Lisinopril
- E. Hydromorphone
正解: B
解説:
Explanation
Metoclopramide may cause tardive dyskinesia when given at a higher dose and for a long duration of time of more than 3 months. Tardive dyskinesia is also listed as a Boxed Warning for metoclopramide. Tardive dyskinesia is a serious movement disorder that is irreversible. The risk increases with duration of treatment and the total cumulative dose. If signs or symptoms of tardive dyskinesia develop, then metoclopramide should be discontinued. There is currently no known treatment for it, but symptoms can lessen or resolve after metoclopramide is stopped. Treatment should not be more than 12 weeks unless the benefits outweigh the risks of developing tardive dyskinesia.
質問 94
CJ is a 69-year-old male with a history of diabetes, hypertension and hypercholesterolemia. His fasting lipid profile is TC 530 mg/dL; LDL-C 125; HDL-C 48 mg/dL; and TG 640 mg/dL. His A1c 8.1, calculate creatinine clearance is 65mls/hr, BP 135/80 mm Hg, HR 70 beats /min.
His current medications include metformin 1000mg po bid, lisinopril 20mg daily, sitagliptin 50mg bid and atorvastatin 40mg daily.
What is the best pharmacological agent to initiate on CJ?
- A. Gemfibrozil 600mg twice daily
- B. Fish oil 500mg twice daily
- C. Fenofibrate 162mg daily
- D. Increase atorvastatin to 80mg
- E. Niacin 500mg twice daily
正解: C
解説:
Explanation
It is reasonable to add triglyceride-lowering medications such as fibrates or niacin to prevent pancreatitis in those with triglyceride levels >500 mg/dL, which applies to this patient as his TG level is 640 mg/dL.
C is wrong because gemfibrozil should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms and rhabdomyolysis. Fenofibrate may be considered concomitantly with a low- or moderate- intensity statin when triglycerides are above 500 mg/dL,2, however he is on a high intensity statin therapy. For niacin, the IR dose should start at 100 mg TID2 and niacin does not lower triglyceride levels as much as fibrate do.4 Fenofibrates are dose adjusted for renal function lower than 60 mL/min to 54 mg/mL, so this dose is appropriate for this patient because of his renal function being above 60 mL/min. The best option is fenofibrate 162 mg daily, but this needs to be monitored for any symptoms of muscle pain exhibited by the patient, especially as the patient is at a higher risk due to being a diabetic. Fish oil is not a first line agent to treat hypertriglyceridemia.
質問 95
Which of the following statements is true regarding Drug-receptor bonds?
- A. Covalent bonds of drugs with receptors are strong and mostly reversible
- B. Electrostatic bonds are stronger than covalent bonds
- C. Hydrophobic bonds are weak bonds and they are important in the interactions of highly water soluble drugs with the lipids of cell membranes
- D. Covalent bonding is much more common than electrostatic bonding in drug-receptor interactions
- E. Bond formation of between the acetyl group of aspirin and cyclo-oxygenase enzyme is a covalent bond
正解: E
解説:
Drugs mainly interact with the receptors by means of chemical forces or bonds. There are three major types of drug receptor bonds: - Covalent - Electrostatic - Hydrophobic Covalent bonds are very strong bonds and in most of the cases they are irreversible under biologic conditions. For example, the covalent bond between the acetyl group of aspirin and cyclo-oxygenase enzyme (target enzyme present on the platelets) does not breaks easily. The platelet aggregation effect of aspirin lasts long after free acetyl-salicylic acid has disappeared from the blood (about 15 minutes) and it is reversed only by the synthesis of new cyclo-oxygenase enzyme in new platelets which takes a long time. Hence the effect of aspirin is seen after the drug is stopped. Among the drug receptor interactions, electrostatic bond is much more commonly found than covalent bond. The electrostatic bonds vary from relatively strong linkages between permanently charged ionic molecules to weaker hydrogen bonds and very weak induced dipole interactions such as van der Waals force. The electrostatic bonds are weaker than covalent bonds. Hydrophobic bonds are usually very weak bonds and probably important in the interactions of highly lipid soluble drugs with the lipids of cell membranes and perhaps in the interactions of the drugs with the internal walls of receptor "pockets".
質問 96
In a study where Rivaroxaban was compared to Enoxaparin to find total VTE following HIP replacement surgery, there were 17 total VTE out of 1513 patients in the Rivaraoaban group and 57 total VTE out of 1473 patient in the enoxaparin group.
What is the absolute risk reduction of using Rivaroxaban over Enoxaparin?
- A. 0
- B. 2.7
- C. 0.27
- D. 1
- E. 2
正解: B
解説:
Explanation
Absolute risk reduction: 0.027 = 2.7% (Event rate in enoxaparin group) - (Event rate in rivaroxaban group) = (57/1473) - (17/1513) = 0.02746
質問 97
Which of the following medication may increase LDL?
- A. Metoprolol
- B. Amlodipine
- C. Diltiazem
- D. Lisinopril
- E. Hydrochlorothiazide
正解: E
解説:
LDL can be elevated by diuretics, cyclosporine, glucocorticoids, and amiodarone.
質問 98
What is the Osmolarity of NS with KCL 40 meq/L? (MW of KCl: 74.55 g/mol) (MW of NaCl: 58.44 g/mol)
- A. 1108 mOsm/L
- B. 800 mOsm/L
- C. 830 mOsm/L
- D. 308 mOm/L
- E. 388 mOsm/L
正解: E
解説:
Explanation
KCl: Osmoles = number of particles in solution Convert 40meq to weight in g: 40meq * 1equiv/1000 mEq *
74.5g/1 equiv = 2.98g of KCL. Calculate mOsm/L: 2.98g/L * 1mol/74.5g * 2Osm/1 mol * 1000mOsm/1 Osm
= 80mOsm/L. NaCl: 0.9g/100ml * 1mol/58.5 g * 2 Osm/1mol * 1000 mOsm/ 1Osm * 1000ml/1L = 308 mOsm/L 80 mOsm/L + 308 mOsm/L = 388 mOsm/L
質問 99
When does the newer chronic kidney disease (CKD) guidelines recommend stopping metformin?
- A. when estimated glomerular filtration (eGFR) is <50 mL/min/1.73 m2
- B. when the estimated glomerular filtration (eGFR) is <30 mL/min/1.73 m2
- C. when creatinine clearance <50 ml/min
- D. when serum creatinine is <1.8 mg/dL
- E. when creatinine clearance <30 ml/min
正解: B
解説:
Metformin should be stopped when eGFR falls below 30. This is the only cutoff that is recommended for absolute discontinuing. If the eGFR falls between 30-44 while ontherapy, benefits and risks of discontinuing should be evaluated. New initiation is only recommended when eGFR >45.
質問 100
Which of these is an example of postrenal acute kidney injury (AKI)?
- A. Dehydration
- B. Renal vein thrombosis
- C. Benign prostatic hyperplasia
- D. Heart failure
正解: C
解説:
Explanation
Benign prostatic hyperplasia (BPH) is an example of postrenal acute kidney injury (AKI). Postrenal AKI, as the name suggests, involves an effect 'post' or 'beyond' the kidney, to problems that emerge downstream from the kidney. BPH is one such example of that. Other examples include kidney stones, bladder stones and bladder cancer.
質問 101
Which of the following antidiabetic medication works by inhibiting carbohydrate breakdown?
- A. Metformin
- B. Dapagliflozin
- C. Sitagliptin
- D. Pioglitazone
- E. Acarbose
正解: E
解説:
Acarbose is an alpha glucosidase inhibitor that inhibits carbohydrate breakdown. Metformin is a biguanide that decreases hepatic glucose production. Dapagliflozin is a SGLT2 inhibitor to decrease glucose reabsorption in the kidney. Pioglitazone is a TZD that increases insulin sensitivity. Sitagliptin is a DPP-4 inhibitor that works on incretins/increase insulin secretion/decrease glucagon secretion.
質問 102
A Physician orders Dobutamine HCl IV infusion at 5 mcg/kg/min. Dobutamine HCl is available as 500 mg in
250 mL of D5W. The patient weighs 68 kg. Calculate the infusion rate in mL/hr.
- A. 5.2mls/hr
- B. 0.17mls/hr
- C. 10.2mls/hr
- D. 22.4mls/hr
- E. 340mls/hr
正解: C
解説:
Explanation
68 kg * [5 mcg/kg/min] = 340 mcg/min Bag concentration = 2 mg/ml or 2000 mcg/ml 340 mcg * [1 mL/2000 mcg] = 0.17 mL/min 60 in * [0.17 mL/min] = 10.2 mLs in one hour
質問 103
A 7-year-old boy has been suffering from influenza and had been given a drug by his father to decrease his high fever. A few hours later, his father brought him to the emergency room in a comatose state with a papulovesicular rash all over the body, moderate hepatomegaly, and asterixis. Laboratory studies reveal elevated levels of blood ammonia, AST, ALT, and PT. CT scan findings are suggestive for generalized cerebral edema.
The drug the father gave his son is most likely which of the following drugs?
- A. Diclofenac
- B. Acetaminophen
- C. Aspirin
- D. Mefenamic acid
- E. Indomethacin
正解: C
解説:
A: The syndrome is an acute noninflammatory encephalopathy with hepatic failure. Although the etiology of Reye's syndrome is unknown, the condition typically follows viral illness, particularly upper respiratory tract infection (URTI), influenza, varicella, or gastroenteritis, and is associated with aspirin use during the illness. A dramatic decrease in aspirin use in children has made Reye's syndrome rare. High index of suspicion is critical for diagnosis. Consider Reye's syndrome in any child with vomiting and altered mental status. Pathogenesis is unclear, but it typically involves mitochondrial dysfunction in a viral-infected, sensitized host, usually with exposure to mitochondrial toxins (e.g., salicylates, in >80% of cases). Individuals with low levels of urea cycle enzymes are also at increased risk. Mortality has fallen from 50% to less than 20% as a result of earlier diagnosis, recognition of milder cases, and more aggressive therapy. Signs and symptoms of Reye's syndrome include protracted vomiting, with or without significant dehydration, encephalopathy in afebrile patients with minimal or absent jaundice, and hepatomegaly in 50% of patients. Antiemetics may mask early symptoms.
Liver function tests reveal elevation of ammonia levels to as much as 1.5 times normal (up to 1200g/dL) 24-48 hours after the onset of mental status changes; this is the most frequent laboratory abnormality.
Transaminases (ALT and AST) increase to 3 times normal. Histologic changes include: hepatocyte cytoplasmic fatty vacuolization, astrocyte edema, loss of neurons, and edema and fatty degeneration in proximal lobules. The American Academy of Pediatrics Committee on Infectious Disease recommends that salicylate not be given to children with chicken pox or influenza
B. B: Acetaminophen is incorrect.
Acetaminophen acts by prostaglandin synthesis in the CNS, and this explain its antipyretic and analgesic properties, which account for its weak anti-inflammatory activity. Acetaminophen is a suitable substitute for the analgesic and antipyretic effects of aspirin in those patients with gastric complaints and to avoid Reye's syndrome in children. C: Indomethacin is incorrect. Indomethacin is more potent than aspirin as an anti- inflammatory agent (NSAID), but it is inferior to the salicylates at doses tolerated by rheumatoid arthritis patients. D: Mefenamic acid is incorrect. Mefenamic acid has no advantage over the other NSAIDS as anti- inflammatory agents. The side effects of mefenamic acid, such as diarrhea, can be severe and associated with inflammation of the bowel. E: Diclofenac is incorrect. Diclofenac is approved for long-term use in the treatment of rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis.
質問 104
Which of the following medication should be avoided in patients with heart failure?
- A. Naproxen
- B. Pioglitazone
- C. All of the above
- D. Celebrex
- E. Cilostazol
正解: C
解説:
Patients with heart failure should avoid taking NSAIDs (which includes naproxen), COX-2 inhibitors, nondihydropyridine calcium channel blockers (for reduced EF), thiazolidinediones (which includes pioglitazone), cilostazol, and dronedarone (for severe or recently decompensated heart failure).
質問 105
Which of the following medication should be avoided if a patient is on lithium to avoid lithium toxicity?
- A. Furosemide
- B. Warfarin
- C. Lisinopril
- D. Amiodarone
- E. Naproxen
正解: E
解説:
ACE-inhibitors (such as lisinopril), NSAIDs (such as naproxen) and loop diuretics (furosemide) can all increase the risk of lithium toxicity.
質問 106
A 22-year-old woman adopted a cat. Shortly thereafter, she developed itchy eyes and persistent rhinorrhea.
She was clearly allergic to the pet, but desperately wanted to keep it. She tried taking diphenhydramine, but it had intolerable side effects.
Which of the following is a common effect of this type of medication?
- A. Decreased intraocular pressure
- B. Diarrhea
- C. Xerostomia
- D. Bradycardia
- E. Excessive sweating
正解: C
解説:
Diphenhydramine possesses anticholinergic properties. Xerostomia, or dry mouth, is a common side effect of anti-cholinergic medications, due to anti-muscarinic, parasympatholytic effects. Other adverse reactions may include: * Mydriasis with blurred vision, photophobia * Urinary retention * Constipation * Anhidrosis * Hyperthermia * Tachycardia * Altered mental status A commonly referenced mnemonic for anti-cholinergic toxicity is "mad as a hatter, red as a beet, dry as a bone, hot as a hare, blind as a bat" to reflect confusion, flushing, dry mouth, hyperthermia and mydriasis, respectively.
質問 107
An 11-year-old male presents with his mother to your clinic with 5 days of frequent diarrhea, occasionally with streaks of blood mixed in. Stool cultures are pending, but preliminary stool samples demonstrate fecal WBC and RBC.
Assuming the patient is stable enough for outpatient management, what would be the optimal treatment assuming the underlying pathogen is Shigella?
- A. Oral Vancomycin
- B. An oral quinolone
- C. Oral TMP-SMX
- D. Oral Metronidazole
- E. Oral Erythromycin
正解: C
解説:
Correct:
E. Shigella can cause bloody diarrhea, and frequently affects young children and institutionalized patients. The pathogen is highly contagious, and is spread via fecal-oral transmission. The pathogen can lead to severe dehydration, and even cause febrile seizures in young patients. For clinically stable patients who can be managed via outpatient therapy, the optimal treatment is via PO TMP-SMX to decrease the risk of person- to-person transmission. Choice A - Erythromycin is the first line treatment for bloody diarrhea caused by the pathogen campylobacter. However, for the purposes of decreasing transmissibility of suspected Shigella, TMP- SMX remains the mainstay of therapy. Choices B + C - Oral metronidazole and oral vancomycin can both be used in the treatment of Clostridium deficile. Alternatively, intravenous metronidazole can be given if the patient is unable to tolerate oral medications. Choice D - Oral quinolones can be used in cases of bloody diarrhea in which salmonella is the suspected pathogen. Salmonella is caused by the ingestion of contaminated poultry and/or eggs, and can ultimately lead to bacteremia in 5-10% of cases.
質問 108
A 23-year-old female presents to your clinic complaining of intermittent throbbing headaches that usually last for several hours and are made worse by the presence of light. She endorses occasional nausea without vomiting during the most severe episodes. Physical examination is unrevealing, and she has no significant past medical history.
Which of the following treatments is considered an abortive therapy for this patient's underlying condition?
- A. Gabapentin
- B. Sumatriptan
- C. Diltiazam
- D. Propranolol
- E. Amitriptyline
正解: B
解説:
Correct:
A. Migraine headaches typically affect females more often than males, and patients most frequently present in their early 20s. Classic symptoms of migraine include throbbing headaches lasting between 2-24 hours in duration, with triggers such as red wine, fasting, stress, and menses. Primary prevention is aimed at the identification and avoidance of triggers. Over the counter NSAIDS can be used if symptoms persist. Failing this, PRN abortive therapy is indicated, including the triptans (e.g. - sumatriptan) and metoclopramide. Choice B - Gabapentin is an anticonvulsant that is considered to be a second-line, prophylactic treatment for recurrent migraine headaches. Its utility is limited by its lengthy side effect profile. Choice C - Amitriptyline, a tricyclic antidepressant, can also be utilized for migraine prophylaxis. However, it will not abort a migraine currently in progress, and extensive side effects limit its use. Choices D + E - Propranolol and diltiazam are beta-blockers and calcium channel blockers, respectively. As with the anticonvulsants and tricyclic antidepressants, these are considered migraine prophylaxis and will not interrupt a migraine once it has begun.
質問 109
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